Obstetric surgeries involve the initiation and completion of one or more incisions, typically as in the case of a caesarean section, through a mother's abdomen (termed a laparotomy) and uterus (termed a hysterotomy) for delivery of one or more babies. Historically, a caesarean section was used as a last resort, in situations when a vaginal delivery was deemed to pose a health risk to the mother or baby. For example, during prolonged labor or a failure to progress to a normal delivery, fetal distress, umbilical cord prolapsed, uterine rupture, hypertension (mother or baby) after amniotic rupture, tachycardia (mother or baby) after amniotic rupture, placental problems, breach or transverse presentation of the baby, failed labor induction, an overly large baby, umbilical cord abnormally, among others. Other complications of pregnancy, preexisting conditions of the mother, and concomitant disease may also indicate the desirability or necessity of a caesarean section.
In recent years, however, caesarean sections have become far more popular, and now comprise a substantial minority of deliveries in the U.S. and abroad. As a consequence, the risks associated with caesarean sections have drawn more attention from the medical community.
In a conventional caesarean section procedure, an abdominal incisions is made, followed by either a midline longitudinal incision in the uterus or, more typically at the present, a lower uterine segment incision. The latter comprises a transverse cut just above the edge of the bladder, and results in less blood loss and facilitates repair, in comparison to the former. In either case, the incisions are typically made with a conventional scalpel, with which the depth of incisions may be difficult to control in some situations, even for a skilled surgeon. In addition, effecting an initial incision requires two acts: first, the scalpel tip is used to perforate the wall of the uterus, followed by reversal of the scalpel in the surgeon's hand to complete the incision. As a consequence, not only is continuity of grip on the scalpel compromised, but also the potential arises for injury to the surgeon, mother and fetus from the scalpel due to a momentary lack of complete control of the instrument.
Attempts to alleviate the aforementioned disadvantages of a conventional scalpel is described in U.S. Pat. No. 7,818,885 to Lafauci et al. Unfortunately, the surgical devices disclosed in the '885 patent require a motion to implement that is foreign to the manner in which surgeons are trained to employ a scalpel. Specifically, not only is a tip, characterized as a “beak,” of a surgical device pointed away from the surgeon when an initial tissue perforation is made, but the incision is completed by pushing the surgical device away from the surgeon rather than being drawn toward him or her in a controlled manner and wherein the blade and tissue being incised are more visible.